THE PSYCHOSOCIAL IMPLICATIONS OF PREEMPTIVE TRANSPLANTATION

Pre-emptive (primary) renal transplantation is occurring with greater frequency as pediatric transplant centers attempt to initiate renal replacement therapy at a time best designed to optimize growth and development in children. Psychosocial benefits of performing pre-emptive transplant are highlighted by an intervention before the child has symptoms of uremia and, thus, develops a self-image as a "sick patient with end-stage renal disease", avoidance of dependence on machine technology, avoidance of a change in parenting that may occur with fears about dialysis, and maintenance of an orientation toward future goals. In addition, the child will likely have less loss of school time and less disturbance in previously established social patterns. Difficulties that may be enhanced in pre-emptive transplantation arise from potentially decreased involvement of the child and family in the medical (transplant) care system prior to transplantation. The two major issues of concern are: (1) optimal education regarding patient (family) responsibility toward quality care of the graft recipient; (2) the accurate assessment of coping skills coupled with the development of optimum psychosocial support from the health care workers and community support services. The provision of a good educational and supportive program is time consuming and financially draining. We must develop creative approaches to these areas in order to enhance each child's opportunity for family and community interaction, as well as physical well-being.